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Home My WebLink About13-091 • Authorization Number 13 ` 91 r 1 (Office Use Only) -.71114rims on II gialr CITY OF IOWA CITY APPLICATION FOR TAXI DRIVER (Police Department review must be made 410 East Washington Street between 8 a.m.to 3 p.m., Monday-Friday.) Iowa City, Iowa 52240-1826. (319) 356-5040 (319) 356-5497 FAX first Middle Last 1. Name d f L '/ A a 11 AD p ✓Al 5 2. Mailing Address 2_1 o g a 11,-4---e � ( `� c I " Cl,-5 1 6 5 3. Telephone: Home 31 l LI 91 1 1 t O Other: ' i ) `� h 9 0 2 4. Prior experience in transportation of passengers: 7 e 1�1 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? /V0 Type of offense Where When 6. Have you b en convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? Q Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? Ye s Type of offense Where When 1vs 6 b 'At, , -`L , - 1 11 8. I as you\r driver's lic e archauf{eur's license been suspended or revoked in the last five years? L � f 7-i 1 3 Type of offense Where When 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) fsa 0 DEPARTMENT OF CRIMINAL INVESTIGATION(DCI) REPORT AND STATE CERTIFIED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF REVIEW You must apply for an individual Department of Criminal Investigation Report(form available upon request). (OVER FOR REQUIRED SIGNATURE AND NOTARY) derwtaxidnvbadg 03/2013 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license nun'er 1 t `Y _, nC I . I understand that if I falsely answer any questions in this application, that this , application may be denied. I understand that if I falsely answer any of the questions in this application, that this application will be denied. I agree that in making this application, I consent to allow agents or employees of the City of Iowa City, Iowa, in their discretion, to examine any and all records and documents relating to this application, and I further agree that, if a license is granted, to comply at all times with all of the provisions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) -- i-/ . io - 2- ' l3 Signature of Applicant. - Date ************************************************************************************************************************************************ STATE OF IOWA ) COUNTY OF JOHNSON ) `�f Sub••c'ibed a . sw. n to, efore me by /C1� � �r � 'S . On this /'//( L- day of 1a�1 s KELLIE K TUTfLE NotaryPublic in and for the State of Iowa y uonmd�o��.n i4urob�r X91819 my c is o Exp res r. low ***** ****************************-,w** ******* *** ***************************************************************************************** I have reviewed this application, DCI report, and the State certified driving record of this applicant and have deter- mined that there is no information which would indicate that the issuance would be detrimental to the safety, health or welfare of residents of the City of Iowa City (Title 5, Chapter 2, City Code). P Si at re Sf Police Chief or designee Date YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY CLERK'S OFFICE. Authorized taxi driver names are placed on the city website at icgov.org. Signature of City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 1/2" (width) and 5 1/1" (height) and prominently displayed to all passengers. ************************************************************************************************************************************************ Office Use Only Approved application DCI report State certified driving record Website update derkriaxidrivbadgeapp2010.doe 03/2013 Page 1 of 2 4 IowaDriver Department of Transportation Office of Services (Toll Free)800-532-1121 PO Box 9204,Des Manes,IA 50306-9204 515-244-9124 FAX:515-239-1837 Certified Abstract of Driving Record Inquiry Date: 3/21/2013 DL/ID#: 713YY6075 (IA) Customer#: 431346 Name: Adams,Adil Daoud Class: A ID Status: None Address: 2608 BARTELT RD APT Audit#: 4078525 DL Status: VAL 2C Issue Date: 07/05/2010 CDL Status: VAL City/State: IOWA CITY,IA Expiration 01/01/2015 CDL Cert None 522462730 Date: Status: Endorsements: LNPT CDL Med None Status: Mailing Address: 2608 BARTELT RD APT Restrictions: Except Class A Bus Restriction None 2CDate of Birth: 1/1/1959 Supplement: Mailing City/State: IOWA CITY,IA Sex: M 522462730 History Information Convictions Citation Date Conviction Date ACD Explanation County 3UR 10/19/2008 112/31/2008 M40 Driving Where Prohibited IL 12/05/2010 •02/18/2011 N40 Improper Signal or Failed to Signal 52 IA ' 08/18/2011 09/29/20.11 .M14 Fail to Obey Traffic Sign/Signal .52 IA • 01/04/2013 01/28/2013 ;M14 Fall to Obey Traffic Sign/Signal .52 IA Accidents -Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number 3UR 07/27/2012 '696745 _,..�.. ........_...._IA , 01/04/2013 719855_..... _ .._... .. __.....-..... IA . .. Name:Adams,Adil Daoud DL/ID: 713YY6075 Pursuant to Iowa Code§321.10, I, Kim Snook, Director of Office of Driver Services,Iowa Department of Transportation, do hereby certify that I am the custodian of the records held by the Office of Driver Services, that this is a true and accurate copy of an official record currently In the custody of said office, and that I have been authorized by the;Director of the Iowa Department of Transportation to so certify. In witness whereof, I have caused my signature and the seal of the Department to be set upon this document, at Ankeny, Iowa this date: •a _-,,,......-. I 3/21/2013 semt IOWA :‘"4 %=:D. O. T. I /il�tytt j1%S `' Office of Driver Services • 3/21/2013 Mar. 27: 20130 9:06AM. Div of Criminal Investigation No. 7817 P. 1/1 niairLL. 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A a d_ 21 '\` J R501011ofiiteprovided name aitd dale of bitYfz revealed: ' viEntorowsCtiufinalliIstorylt000rdNutt with 1)CY ,;, Et Iowa CriminalNlieiozyRoCol'd attached,Dalt • Received Time Mar, 22. 2013 2;02MNo, 804